After you complete these optional forms, print and sign and either drop this off at our office, mail, or fax.

Release of Information to Inspire Family Health  This signed form allows an outside medical provider or practice to send your medical records to us.

Release of Information from Inspire Family Health  This signed form allows us to send your medical records to another medical provider or practice.

Personal Representative Designation  This form allows us to share your personal medical information with a spouse, relative, friend or person that you choose.  Although this is optional, we highly recommend having a Personal Representative Designation on file with us (and a copy for you.)  Sometimes this information may be needed during times of crisis or times when you need an advocate.  You would only want to designate someone as your Personal Representative if you are comfortable with that person having access to your personal medical information and you can also restrict the information that is disclosed.